De novo arthropathy following glucocorticoid treatment for severe alcohol-associated hepatitis: Five case reports

Table 1 Baseline, liver, and joint characteristics of patients included

	Case 1	Case 2	Case 3	Case 4	Case 5
Age (years)	64	38	53	56	44
Sex	Female	Female	Male	Female	Male
AST/ALT (IU/L)	57/27	91/34	390/115	115/44	306/90
Total bilirubin (mg/dL)	3.7	6.4	12.3	11.9	20.1
Albumin (g/L)	21	25	35	27	33
INR	1.85	1.73	1.33	2.31	1.19
MELD score	18	20	19	25	20
Maddrey DF	43	45	33	81	34
CRP (mg/dL)	0.40	< 0.4	< 0.4	< 0.4	< 0.4
ESR (mm/hour)	69	-	9	36	20
Clinical complications of liver disease	Jaundice; moderate ascites; respiratory infection	Jaundice; moderate ascites; urinary tract infection	Jaundice; mild ascites	Jaundice; moderate ascites; variceal bleeding; hepatic encephalopathy	Jaundice; mild ascites
Steroid posology for AH	Initial: PRED 40 mg/24 hours for 7 days	Initial: PRED 40 mg/24 hours for 28 days	Initial: PRED 40 mg/24 hours for 2 months1	Initial: PRED 40 mg/24 hours for 7 days	Initial: PRED 40 mg/24 hours for 28 days
	Tapering: 10 mg every 48 hours	Tapering: 10 mg every week	Tapering: 10 mg every week	Tapering: No tapering	Tapering: 10 mg every week
Response (Lille score)	Non-responder (0.585)	Responder (0.052)	Responder (0.030)	Non-responder (0.534)	Responder (0.070)
Joint manifestations	Soreness in both shoulders; no swelling; morning stiffness and functional disability	Symmetric soreness and pain in shoulders, knees and IPH/MCPH joints; no swelling; morning stiffness and functional disability	Symmetric soreness and pain in shoulders, hips and IPH/MCPH joints; IPH/MCPH swelling; morning stiffness and functional disability	Pain in both shoulders and knees; no swelling; morning stiffness and functional disability	Symmetric soreness in shoulders, hips and knees; no swelling; no stiffness or functional disability
Ultrasound findings	Subscapularis tendinopathy	Unremarkable	Bilateral tenosynovitis in flexor hand muscles and synovial hypertrophy in MTPH joints	Left shoulder: Supraspinatus and subscapularis tendinopathy; right shoulder: Unremarkable	Unremarkable
Final diagnosis of joint disease	Polymyalgia rheumatica	Arthralgia associated with glucocorticoid cessation	Psoriatic arthritis	Arthralgia associated with glucocorticoid cessation	Arthralgia associated with glucocorticoid cessation
Treatment of joint disease	Initial: Oral mPSL 12 mg/24 hours	Initial: Oral mPSL 8 mg/24 hours	Initial: Oral mPSL 8 mg/24 hours	No treatment	Initial: Oral mPSL 10 mg/24 hours
	Maintenance: MPSL 3 mg/24 hours	Maintenance: No treatment	Maintenance: Adalimumab 40 mg/2 weeks		Maintenance: No treatment

¹Case 3 was treated with prednisone 40 mg for 2 months due to a misunderstanding of the prescribed regimen.

AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; INR: International normalized ratio; MELD: Model for end-stage liver disease; DF: Discriminant function; CPR: C-reactive protein; ESR: Erythrocyte sedimentation rate; PRED: Prednisone; AH: Alcohol-associated hepatitis; IPH: Interphalangeal; MCPH: Metacarpophalangeal; MTPH: Metatarsophalangeal; mPSL: Methylprednisolone.